Notes for Appointment with Dr. Marquis (6/11/15)

1. OVERVIEW: My cough is still frequent and persistent, though it varies day by day and hour by hour, sometimes mostly going away for hours at a stretch, but always coming back. It’s usually (but not always) worst in the evenings and when I’m supine. The only major improvement since my appointment 6 weeks ago is that (since I began taking the Advair regularly on May 20) at least I’m no longer having the severe coughing fits that made me almost fall down!

2. SLEEP: The cough still often wakes me up or makes it difficult to fall asleep. On 6/6/15, my psychiatrist prescribed a bit of Seroquel (25-50 mg/night), which has been helping me to sleep more, but the coughing still often wakes me up, usually after only 4 or 5 hours of sleep.

3. PHLEGM: The throat clearing hasn't improved at all. It’s nearly constant and feels very phlegmy, though it’s not productive. Should I even continue taking the Wal-Fex and Nasonex if I still have this much phlegm?

4. SHORTNESS OF BREATH: I sometime feel like I can't get enough air in my lungs, even when I’m not doing anything active, just relaxing. (This has been happening the entire time I’ve had this cough, for the past 2 months.) It seems worse when I’m lying down. I get out of breath when climbing stairs and such, but not when just walking at a regular pace. Would it be useful to have an inhaler for the acute coughing fits and/or times when I’m feeling very short of breath? Is this even being caused by asthma?

5. OVEREXERTION: When I overexert myself (like running too many errands, walking too fast/far, or attending an all-day wedding), the bad coughing comes back that night (& usually the next day), but not necessarily *during* the activity.

MENTAL HEALTH EFFECTSI am being treated for mental health issues, primarily bipolar disorder and severe anxiety, both of which are being affected by the cough situation.

1. ANXIETY: Feeling like I can’t breathe is a big trigger for my chronic severe anxiety, so this shortness of breath sometimes makes me panic a little, so I get up and move around instead of lying down to sleep. (This is another way the situation interferes with my sleep.)

2. BIPOLAR DISORDER: My mood has been balanced for a long time, but this extended period of sleep deprivation (caused by coughing) has triggered an episode of hypomania. My psychiatrist has made some changes to my psych meds: -- reduced Zoloft from 37.5 to 25 mg on 6/6/15 -- seems to have had no effect on hypomania -- added Seroquel to help me sleep at night 6/5/15 -- has helped me sleep, but has not helped hypomania